目的 探讨维持性血液透析(MHD)患者肾性贫血纠正情况及其影响因素.方法 收集2017年9月至2019年9月行MHD治疗患者188例.根据血红蛋白水平分为A、B、C、D四组,比较各组间基线水平及CRP、TSAT、SF、preALB、ALB、iPTH、Ca2+、P3-、TG、TC等实验室指标的差异,分析影响肾性贫血达标的影响因素.结果 preALB、ALB、TSAT水平,A组>B组>C组>D组逐渐降低,四组比较差异有统计学意义(P<0.05).iPTH、P3-、CRP水平,A组0.05).结论 MHD患者肾性贫血治疗达标率较低,透前CRP、TSAT、preALB、ALB、iPTH、P3-是MHD患者贫血不达标的影响因素.

目的 探讨自拟慢泡快冲改良预充法在无肝素抗凝血液透析(hemodialysis,HD)中的临床应用价值. 方法 选择2018年1月～2019年3月间桐乡市第一人民医院血液净化中心行无肝素抗凝的血液透析患者38例,随机分为2组.A组:采用传统方法进行透析器及管路预充;B组:采用慢泡快冲改良法进行预冲.每组19例,每例患者观察周期4例次.记录透析过程中透析器及管路凝血评级、生理盐水冲洗次数、透析时间等,并于第4例次HD时测定eKt/V 结果相比采用传统方法,B组患者在透析器、透析管路凝血0级、Ⅱ级、Ⅲ级的比较差异均有统计学意义(t值分别为7.851,3.437,8.774;P值分别为0.013,0.009,＜0.001);生理盐水冲洗次数比较中,0次、1次、3次、≥4次经比较差异具有统计学意义(t值分别为7.602,8.959,5.848,8.192;P值分别为0.031,0.006,0.024,0.018);2组HD时间≥3h的百分率分别为87.2％、97.4％,经比较差异具有统计学意义(t=6.752,P=0.011);2组eKt/V达标率比较差异具有统计学意义(t=8.039,P=0.023). 结论 自拟慢泡快冲改良预充法在无肝素抗凝HD治疗中,应用简单、经济、安全,且不影响透析充分性.

目的 分析金华市磐安县维持性血液透析(MHD)老年患者的营养状况及其影响因素,为预防和干预MHD老年患者营养不良提供依据.方法 于2017年4月—2018年2月选择磐安县人民医院就诊的MHD老年患者为研究对象,收集透析龄、透析频率等临床资料,采用相关量表评估睡眠质量、日常生活活动能力、焦虑和抑郁情况,采用主观整体营养状况量表评估营养状况,采用无序多分类Logistic回归模型分析MHD老年患者营养状况的影响因素.结果 MHD老年患者278例,营养良好165例,占59.35％;营养不良113例,占40.65％.其中轻度营养不良92例,占33.09％;重度营养不良21例,占7.55％.无序多分类Logistic回归分析结果显示,透析龄≤26月(OR=0.548,95％CI:0.361～0.834;OR=0.516,95％CI:0.342～0.777)、非独居(OR=0.481,95％CI:0.331～0.698;OR=0.454,95％CI:0.319～0.646)、独立生活能力中等及以上(OR:0.303～0.309,95％CI:0.231～0.399;OR:0.290～0.297,95％CI:0.209～0.404)和无抑郁(OR=0.508,95％CI:0.348～0.742;OR=0.479,95％CI:0.334～0.686)是MHD老年患者轻度和重度营养不良的保护因素;透析频率≤2月/次(OR=1.479,95％CI:1.058～2.066;OR=1.643,95％CI:1.103～2.440)和不参加锻炼(OR=1.638,95％CI:1.179～2.275;OR=1.631,95％CI:1.055～2.521)是MHD老年患者轻度和重度营养不良的危险因素.结论 磐安县MHD老年患者营养不良发生率较高,透析龄、透析频率、是否独居、是否参加锻炼、独立生活能力和有无抑郁与MHD老年患者营养不良有关.

Objective To explore the influencing factors of quality of life and negative emotions in maintenance hemodialysis(MHD)patients. Methods 188 cases of maintenance hemodialysis in Zhejiang medical &health group Hangzhou Hospital and Haining People's Hospital from September 2017 to September 2018 were selected. Self-rating Depression Scale(SDS)and Self-rating Anxiety Scale(SAS)were used to assess patients' emotional status,Meanwhile,CRP,Hb,SF,Alb and dialysis adequacy(KT/V)indicators which reflecting the quality of life of hemodialysis patients were evaluated,and the influence factors of quality of life on negative emotions of maintenance dialysis patients were analyzed. Results Among 188 MHD patients,the incidence of depression(SDS≥50)was 38.8%,and anxiety(SAS≥50)was 37.8%. The SDS and SAS scores of MHD patients with age>60 years,dialysis age>1year or diabetes mellitus were significantly higher than those of MHD patients with age ≤60 years,dialysis age ≤1 year or without diabetes mellitus,statistical difference was statistically significant(P<0.05);Hb,SF and Alb were negatively correlated with SDS and SAS(r was -0.38,-0.31,-0.26,P<0.05);and S-CRP was positively correlated with SDS and SAS(r=0.28,P<0.05). Conclusion The incidence of negative emotions is higher in MHD patients,and the quality of life affects the negative emotions of MHD patients.

目的:建立C57BL/6小鼠腹膜间皮细胞(peritoneal-mesothelial-cells,PMCs)的体外培养方法.方法:选择8周龄C57BL/6雄性小鼠,0.25％胰蛋白酶-EDTA消化C57BL/6小鼠大网膜,细胞悬液经离心培养,进行形态学及细胞免疫组化鉴定.结果:分离培养的C57 BL/6小鼠PMCs倒置显微镜下呈小圆形细胞,部分细胞聚集成小串葡萄状;72 h所有贴壁细胞均伸展,呈梭形等,边缘不整,细胞呈现拉网生长,与相邻的细胞相互连接;HE染色呈现多边形、椭圆形、短梭形,细胞浆染为淡红色;细胞免疫荧光组化鉴定上皮细胞标志分子E-cadherin及间充质标志分子Vimentin表达呈阳性,证实培养的细胞为PMCs.结论:C57 BL/6小鼠腹膜间皮体外细胞培养成功,可为后续腹膜透析相关腹膜纤维化相关体外研究的开展提供可靠的细胞模型.

目的:评价人体成分测量在血液透析患者营养状态评估中的运用价值.方法:选择2017年02月～2018年10月间我院血液净化中心透析龄大于3个月的维持性血液透析(maintenance hemodialysis,MHD)患者196例,采用多频生物电阻抗法(bioelectric impedance analysis,BIA)进行人体成分测量,内容包括:体质量指数(BMI),体脂比,瘦体重(体重-脂肪重量),水过多(Over Hydration,OH),干瘦体重(瘦体重-OH),细胞外液与总体水之比(ECW/TBW),结合血清营养指标评价患者营养状态.结果:两两比较显示:对MHD患者营养不良判断的评价,人体成分测量中的干瘦体重指标明显优于瘦体重指标及血清中白蛋白(Alb),前白蛋白(PAB),转铁蛋白(Tf)、胆固醇(TC)对患者营养不良的判断(P<0.01);瘦体重指标对患者营养不良的判断优于血清中白蛋白,前白蛋白,转铁蛋白、胆固醇对营养不良的判断(P<0.01).Spearman相关分析结果显示:人体成分测量中的干瘦体重与BMI、体脂百分比呈正相关(r=0.294及r=0.183,P均<0.05),与患者年龄、ECW/TBW及OH值呈负相关(r=-0.215,r=-0.198及r=-0.447,P均<0.05);Logistic回归分析显示:干瘦体重、年龄、OH值为MHD患者营养不良的独立危险因素.结论:生物电阻抗技术较血清学对MHD患者营养不良的评估具有无创、经济、灵活等优点,可用于MHD患者早期营养不良的判断及指导临床对患者营养不良进行干预.

Objective To understand the prevalence of chronic kidney disease (CKD) among rural residents of north central areas of Zhejiang,and to analyze the related risk factors.Methods A total of 1 654 native residents aged ≥18years and living at least 5 years in the areas were selected from four villages in north-central areas of Zhejiang.All participants completed the questionnaire about the risk factors related to CKD and received physical examination as well as urine and blood test.The standardized prevalence of CKD was calculated based on the distribution of age and gender in the sixth census data in rural areas of Zhejiang.Risk factors related to CKD were analyzed by univariate analysis and multivariable logistic regression analysis.Results After adjusting the age and gender,the overall prevalence of CKD was 9.44％ (95％ CI:8.03-10.85),the prevalence of albuminuria and reduced renal function were 8.02％ (95％CI:6.71-9.33) and 2.65％ (95％CI:1.88-3.42).The awareness rate for CKD was 6.49％.Gender,age,BMI,SBP,FBG (fasting blood-glucose),blood uric acid were found to be independent risk factors of CKD,while DBP,cholesterol,HDL-C,LDL-C and triglyceride were factors unrelated to CKD.Conclusions The prevalence of CKD of rural residents in north-central areas of Zhejiang shows a up-ward trend along with age and the increase of BMI,SBP,FBG and blood uric acid.The prevalence of female residents is significantly higher than male individuals.

尿毒症是各种慢性肾脏疾病的最终发展结局,严重威胁健康甚至生命.尿毒症患者可以选择血液透析、腹膜透析或者肾移植作为肾脏替代治疗,但目前使用最为广泛的还是血液透析治疗.大部分尿毒症患者在进入血液透析时尚存在小部分肾功能,即残余肾功能(residual renal function,RRF).RRF是指肾组织受损后健存肾单位残存的功能,包括清除体内毒素、调节电解质平衡及内分泌功能.近年来,RRF的重要性日益受到关注,但目前对于血液透析患者的RRF研究相对较少,本次研究就血液透析患者RRF的重要性及保护措施加以综述.

Objective To survey the prevalence of metabolic syndrome (MS) and chronic kidney disease(CKD) among rural residents of north-central region of Zhejiang province and to investigate the association between two diseases. Methods A cross-sectional survey on the prevalence of MS and CKD was conducted with questionnaire, physical examination and laboratory examination. Total 1 627 residents aged ≥18 years, who had lived in rural area of north-central Zhejiang(Pan'an, Haining and Tongxiang) for ≥5 years, were selected as participants. The age-standardized prevalence of MS and CKD was calculated according the 6th population census of Zhejiang province, and the association between the prevalence of CKD and MS was analyzed. Results In 1 627 participants, there were 218 cases of MS with a prevalence rate of 13.40％ (95％ CI: 12.76～16.20％) and 202 cases of CKD with a prevalence rate of 12.42％ (95％ CI: 8.03～10.85％). Compared to non-MS subjects, the BMI, waist circumference, SBP, DBP, UA,FBG, TG, TC in MS residents were higher (All P＜0.05), and HDL-C was lower (P＜0.05), but there were no significant difference in age, serum creatinine, and LDL-C between the two groups (P ＞ 0.05). The prevalence of CKD in MS patients was higher than that in non-MS residents (22.02％ vs 10.93％, P＜0.05). Conclusion The prevalence of CKD with MS among rural residents in north-central Zhejiang is relatively high, and the prevalence rate of CKD in MS patients is higher than that in non-MS inhabitants. So screening of CKD and early intervention of MS are necessary.

Objective To investigate the morbidities of hypertension and chronic kidney diseases (CKD) and related risk factors of the residents in four villages,and to provide the basis for intervening measures of CKD.Methods From April 1 to December 31 of 2015,simple random sampling method was used to select the residents (≥ 18 years old) with ≥ 5 years inhabitancy duration from 118 groups of villagers in four villages as the subjects.The investigation was conducted with questionnaire of CKD risk factors,physical examinations and laboratory tests.The subjects were 1 627 rural residents.According to the data of age and gender distribution of rural population in 6th demographic census of Zhejiang Province,the standardized morbidities of hypertension and CKD were calculated.The t test,x2 test and multiple factor two classification logistic regression analysis were used to analyze the data with SPSS 19.0 software.Results The crude morbidity of hypertension was 50.40％ (820/1 627),the standardized morbidity of hypertension was 39.32％.The crude morbidity of CKD was 12.42％ (202/1 627),the standardized morbidity of CKD was 9.44％.As the hypertension group was compared with the non-hypertension group,the age was older,the rural residents were much more,education level and economic level were lower in the hypertension group (P＜0.01).But there were no significant differences of smoking,drinking and life style between two groups (P＞0.05).The levels of BMI,WC,SBP,DBP,SCr,UA,FPG,TG,TC and LDL-C in the hypertension group were significantly higher than those in the non-hypertension group (P＜0.05 or P＜0.01).But there was no significant difference of HDL-C between two groups (P＞0.05).The crude morbidities of albuminuria,low eGFR and CKD in hypertension group were 14.27％,5.12％ and 17.20％,respectively which were significantly higher than those (6.69％,1.73％ and 7.56％) in non-hypertension group (P＜0.01).Multiple factor two classification logistic regression analysis showed that age,hypertension,diabetes and hyperuricemia were related to C KD (OR values were 2.116,1.986,2.778 and 1.973,P＜0.01).Conclusion The morbidity of hypertension in the four villages of Zhejiang Province was high.More attention should be paid to screening of CKD for hypertension patients,specially for older hypertension patients and hypertension patients with T2MD and hyperuricemia.

男青年小张平时能做100多个俯卧撑,可这一天,他整整做了600个俯卧撑.做完后,小张感觉肌肉有点酸痛.当天晚上,他发现尿液颜色有点变深了.第二天,他全身肌肉酸痛,出现了恶心、呕吐等症状.后来,尿液都变成了酱油色.

目的 探讨浙江中北部农村居民慢性肾脏病(chronic kidney disease,CKD)发病率与体质指数(body mass index,BMI)及性别差异的相关性.方法 于2015年4-12月对浙江中北部(磐安县高二乡、海宁市永福村、海宁市许桥村、桐乡市路家园村)4个不同村落、118个村民小组内居住5年以上的18岁以上原住居民进行慢性肾脏病问卷调查,并进行体质指数(body mass index,BMI)、肾脏损伤指标及相关危险因素检测.结果 经浙江省第六次人口普查数据中乡村地区人口经年龄性别分布标化后,在资料完整的1 627例居民中白蛋白尿(ACR)患病率为7.88％、肾小球滤过率(eGFR)下降患病率为2.37％,CKD患病率为9.21％,且女性患病率高于男性;根据体质量判断标准,共筛查出体重正常者851例,体重过低者54例,超重者578例,肥胖者144例,其中:BMI在18.5 ～23.9 kg/m2 ACR及CKD检出率较高;二分类Logistic回归分析显示,性别、年龄、高血压史、空腹血糖、尿酸、BMI均是CKD的独立危险因素.结论 浙江中北部四个村落农村居民CKD患病率随BMI增加有增长趋势,且女性患病率高于男性.

目的:探讨生活行为方式对浙江中北部农村居民慢性肾脏病(CKD)患病率的影响.方法:对浙江中北部(磐安县高二乡、海宁市永福村、海宁市许桥村、桐乡市路家园村)4个不同村落、118个村民小组内居住5年以上的18岁以上1 627例原住居民进行包括吸烟、饮酒、食盐口味、体力活动强度及业余爱好等生活行为方式问卷,同时测定研究对象的人体参数及ACR、eGFR,应用SPSS19.0统计软件对研究对象进行生活行为方式与CKD患病率进行分析.结果:受检居民以女性、年龄50～69岁者居多,各占63.00％及63.74％;该地区居民对目前生活、经济收入及健康状况满意度较高,经人口年龄性别标化后,该人群白蛋白尿患病率为10.51％,eGFR下降患病率为3.44％;CKD患病率为9.21％(95％CI7.80～10.63);该人群BMI、WC、WHR、TG、UA异常及患有代谢综合征(MS)、高血压、糖尿病人群CKD患病明显高于非CKD人群,经比较差异具有统计学意义(P值均小于0.05);但包括吸烟与否、饮酒、食盐口味、体力活动强度等不良生活行为方式均与ACR异常、eGFR下降及CKD患病均无明显关系(P值均＞0.05).结论:该人群代谢成分异常与CKD患病有一定关联,但与不良生活行为方式无明显关联.

目的 调查浙江中北部农村男性居民的吸烟状况及慢性肾脏病(chronic kidney disease,CKD)患病率,为全民戒烟提高依据.方法 问卷调查浙江中北部1627例原住居民进行包括吸烟相关的生活行为,测定研究对象的人体参数及尿液白蛋白和肌酐比值(ACR)、估算肾小球滤过率(eGFR).结果 该人群成人男性吸烟率54.82％,女性吸烟率1.76％;经人口年龄性别标化后,该人群ACR患病率为7.88％(95％CI6.57～9.20),eGFR下降患病率为2.37％(95％CI 1.63～3.11),CKD患病率为9.21％ (95％CI 7.80～ 10.63);吸烟者血清肌酐(Scr)及尿酸(UA)水平明显高于非吸烟者,经比较差异具有统计学意义(P均＜0.001);男性中吸烟者ACR、eGFR下降及CKD患病率分别为6.36％、2.72％及8.48％;与非吸烟者相应指标差异无统计学意义(P均＞0.05).结论 该人群吸烟者与非吸烟者的慢性肾脏病患病率无明显差异,吸烟者Scr及UA水平明显高于非吸烟者.

终末期肾病是威胁人类健康的重要疾病之一。由于肾源的限制，血液透析和腹膜透析成为主要的治疗手段。鉴于治疗方法的特殊性，透析病人面临生理、心理、社会功能等方面的压力，导致生活质量下降。随着传统医学模式向生物-心理-社会模式的转变，临床工作者的视野不再局限于患者生命的维持，而转为更多地关注患者生活质量的改善。在无明显适应证和禁忌证的前提下，选择何种透析方式对患者生活质量更有利，以及如何提高生活质量是一个值得探索的问题。本次研究就血液透析和腹膜透析患者生活质量研究进展加以综述。

腹膜透析是终末期肾脏病患者的重要替代方式之一,具有居家方便,对血流动力学影响小,能有效保护残余肾功能等优点,但腹膜透析也存在着一些并发症如腹膜炎、腹膜纤维化、胸腹漏等,其中腹膜透析并发胸腹漏不但影响腹膜透析效果,同时对患者的心肺功能造成很大影响,严重者甚至威胁患者生命.现对浙江省人民医院2013～2014年腹膜透析并发胸腹漏的2例患者的临床表现、诊断、治疗、转归进行分析,结合文献进行相关分析报道如下.

抗中性粒细胞胞浆抗体(anti-neutrophil cyto-plasmic antibodies,ANCA)相关性血管炎(ANCA-as-sociated vasculitis,AAV)是以血管壁炎症或纤维素样坏死为基本病理特征的一组自身免疫性疾病,可累及全身各处小血管, 其中肾脏是最易受累的脏器,且病程进展迅速,短期内可进展至急性肾衰竭,早期干预可明显改善患者预后. 本次研究报道AAV肾损害的病例1例,结合文献进行相关分析.

Objective To evaluate the effects of Rosuvastatin on serum IL- 6 and lipid in high- fat diet- induced obese rats. Methods Thirty male rats were divided into obese(n=20) and control(n=10)groups randomly, and fed a high- fat diet and a standard diet,respectively,for 14 weeks. Obesity was determined based on body weight increment. Serum TC、TG、HDL- C 、LDL- C and IL- 6 were measured. Obese rats were treated with Rosuvastatin. Serum lipid and IL- 6 were compared before and after treatment of Rosuvastatin. Results The levels of serum TG, TC, LDL- C and IL- 6 were significantly higher in obese group than those in the control group(P<0.01) .The level of IL- 6 was significantly correlated with TC and LDL- C levels (r=0.72、0.71, P<0.01). Rosuvastatin significantly decreased serum lipid and IL- 6 of obese rats. Conclusion Serum IL- 6 increases obviously in high- fat diet- induced obese rats. Rosuvastatin could reduce serum IL- 6 as wel as lipid.

Objective:To observe the effects of Xuezhikang on adiponectin, inflammatory cytokines, and 24 h urinary protein in obesity-related glomerulopathy (ORG) rats,in order to investigate the renal protective mechanism of Xuezhikang on ORG rats. Methods:Thirty male Wistar rats were randomly divided into normal group,model group, and Xuezhikang group,10 rats in each group. Normal group was fed on normal diet,model group was fed on high fat diet,and Xuezhikang group was fed with both high fat diet and Xuezhikang,totally for 12 weeks.The followings were observed:serum adiponectin,interleukin-6 (IL-6),tumor necrosis factor-α(TNF-α),24 h urinary protein,and renal pathological alterations. Results:After 12 weeks,compared with the normal group,the model rats' serum adiponectin reduced,and IL-6 and 24 h urinary protein increased,all with statistically significant differences (P<0.01),but TNF-α elevated without a significant difference between the two groups (P>0.05);and the alteration of renal pathology in the model group was more tremendous than that in the normal group. Compared with the model group,Xuezhikang group had higher adiponectin, lower IL-6 and 24 h urinary protein(P<0.01),and renal pathologi-cal damage mitigated. Conclusion:Xueazhikang may play a renal protective effect on ORG rats by downregulating the expression of inflammatory cytokines such as IL-6,and increasing anti-inflammatory cytokines levels like adiponectin.

Adiponectin,a circulating plasma protein primarily secreted by adipocytes,has been recently recognized to correlate with obesity,insuin resistance,type 2 diabetes,atherosclerosis and metabolic syndrome,and plays an important role in these diseases.The effect of adiponectin is also regarded to be important in kidney diseases.The concentration of adiponectin is variable in different kidney diseases,and is closely related to renal dysfunction.